Effects of equine-assisted services in psychiatric disorders: a systematic review

Abstract

For several years, psychosocial rehabilitation programs have been offered to psychiatric patients as a complement to pharmacological treatment. These programs include Equine-Assisted Services (EAS). Horses are social, highly attentive, and emotionally sensitive animals, making equine-assisted interventions a particularly suitable complementary therapy. This systematic review aimed to evaluate the current state of knowledge regarding the effects of EAS on biopsychosocial outcomes in psychiatry. In accordance with PRISMA guidelines, Embase, EBSCOhost, PubMed, and Web of Science were searched up to February 10, 2026. Only primary research articles in English or French targeting populations with diagnosed psychiatric conditions, involving live horses, and reporting qualitative or quantitative biopsychosocial outcomes were included. Reviews and meta-analyses were excluded. Study quality was evaluated using the Mixed Methods Appraisal Tool, and data were analyzed using spreadsheets and pivot tables. Out of 888 identified records, 107 articles were included, representing 3,097 participants (65% male). The literature comprised quantitative (40% longitudinal, 17% randomized controlled trials, 12% non-randomized trials), qualitative (22%), and mixed-methods studies (9%), predominantly published by American (49%) or European (35%) teams. Study populations included children/adolescents (55%), adults (24%), and veterans (21%). Interventions primarily targeted neurodevelopmental (43%) and trauma-related disorders (25%). Most programs (78%) combined riding with unmounted activities but lacked standardization in terminology, content, and duration. EAS demonstrated substantial benefits for clinical symptoms, quality of life, and biopsychosocial skills, yielding 99% positive qualitative results and 69% positive quantitative results. The largest improvements occurred in symptom severity, social skills, and motor skills in neurodevelopmental disorders. However, overall methodological quality was low, with widespread biases, small sample sizes, and a frequent lack of control groups or statistical testing. EAS represents a promising and innovative complementary therapy in psychiatry. This review highlights the need for standardized programs and more rigorous research with high levels of evidence (randomized controlled trials) to scientifically validate their effectiveness on clinical symptoms and psychosocial skills. PROSPERO, CRD42021246614. All data generated or analysed during this study are included in this published article.